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At least 883 records · Page 49Linked to original sources
PubMed2006

Throwing shoulder injury involving the anterior rotator cuff: concealed tears not as uncommon as previously thought.

PURPOSE: In throwing athletes, partial rotator cuff tears are usually located posterior to the site of the common rotator cuff tears seen in the general nonthrowing population. However, they sometimes have tears located around the anterior aspect of the supraspinatus tendon. In this study we investigated the characteristics of anterior rotator cuff tears in throwing athletes. We then compared several factors between anterior tears and posterior tears to investigate those related to the presence of anterior tears or the occurrence of such tears. METHODS: We divided 37 athletes with partial rotator cuff tears into those with anterior tears (n = 17) and those with posterior tears (n = 20). The clinical profile, range of motion and joint laxity with patient under general anesthesia, and operative findings were retrospectively compared between the 2 groups. RESULTS: Among the 17 anterior rotator cuff tears, 12 tears were confined to the anterior one third of the supraspinatus tendon. Interestingly, concealed intratendinous degenerative tears were found in 6 shoulders. These appeared to be very shallow articular-side tears located around the attachment of the greater tuberosity, but severe tears were exposed after resection of the residual capsular portion of the tendon. Posterior capsular tightness was significantly related to the occurrence of anterior tears, whereas a greater tuberosity notch was significantly related to posterior tears. CONCLUSIONS: Anterior rotator cuff tears are not uncommon in throwing athletes, and a concealed type of tear was a representative lesion. Different mechanisms may be involved in the development of anterior and posterior rotator cuff tears resulting from throwing injuries. Posterior capsular tightness might influence the occurrence of anterior tears. LEVEL OF EVIDENCE: Level IV, prognostic case series.

Athletic Injuries↗
PubMed2003

Arthroscopic surgery for partial rotator cuff tears.

Rotator cuff pathology is one of the most common disorders of the shoulder. However, partial rotator cuff tears, treatment, and natural history are still in a state of flux. We believe that partial rotator cuff tears should be treated surgically when the rotator cuff is torn more than 50% of the thickness or when substantial thinning of the rotator cuff is identified arthroscopically. We believe that the technique described here addresses the need for increased blood supply in the rotator cuff and diminishes the chance for extension to a complete rotator cuff tear. The technique and postoperative rehabilitative regimen is described.

Arthroscopy↗
PubMed2003

Internal impingement in the etiology of rotator cuff tendinosis revisited.

PURPOSE: The theory of internal impingement holds that, in overhead athletes, repeated contact between the undersurface of the rotator cuff and the posterosuperior glenoid rim leads to articular-sided partial-thickness rotator cuff tears and superior labral lesions. However, we have noted this same constellation of lesions in our general patient population. These recreational athletic patients do not routinely assume the position of extreme abduction and external rotation, and thus are unlikely to experience significant internal impingement forces. The goal of this study was to document the prevalence of superior labral lesions in patients being treated for partial-thickness undersurface rotator cuff tears. TYPE OF STUDY: Retrospective case series. METHODS: We retrospectively reviewed the records of 75 shoulders arthroscopically treated for partial-thickness articular-sided rotator cuff tears. With the exception of one professional tennis player, no patients were playing sports at a professional or major college level. No professional or collegiate throwing athletes were included. The prevalence of these lesions and their association with recreational athletics was noted. RESULTS: We found that 55 of 75 (73.3%) shoulders with articular-sided partial-thickness rotator cuff tears also had superior labral lesions. A statistically significant increased prevalence of superior labral lesions in the dominant shoulder was seen (P =.03). In addition, our patients who engaged in overhand throwing had significantly fewer superior labral lesions in the dominant shoulders than did nonthrowers (P =.017). CONCLUSIONS: The "kissing lesions" of undersurface rotator cuff tears and posterosuperior labral damage may be explained by mechanisms other than "internal impingement."

Adolescent↗
PubMed1994

Arthroscopic subacromial decompression in the treatment of full thickness rotator cuff tears: a 3- to 6-year follow-up.

Arthroscopic subacromial decompression has become an accepted treatment for patients with impingement syndrome; however, its use for full thickness rotator cuff tears continues to be controversial. The purpose of this study is to determine if the results of arthroscopic subacromial decompression alone for full thickness rotator cuff tears deteriorate at long-term follow-up. We reevaluated all 25 patients with full thickness rotator cuff tears who underwent arthroscopic subacromial decompression from our original study group. Based on the University of California at Los Angeles shoulder rating, 68% of patients were rated as excellent or good at the present mean follow-up of 45.8 months (range 36-72 months). This represents a significant decrease from our initial report of 84% satisfactory results at a mean follow-up of 24.6 months. There was a significant decrease in ratings with regard to pain and function; however, no significant deterioration was noted with regard to motion and strength. Two additional patients required open rotator cuff repair since the time of initial follow-up for a total of six. Large and massive rotator cuff tears fared worse over time as compared with small and moderate size tears. Although 1- to 3-year results of arthroscopic subacromial decompression and rotator cuff debridement were favorable, the long-term follow-up demonstrates deterioration of results. We therefore cannot support the use of decompression and debridement alone in the treatment of repairable full thickness rotator cuff tears.

Adult↗
PubMed1996

Histological analysis of the coracoacromial arch: correlation between age-related changes and rotator cuff tears.

The purpose of this study was to analyze age-related changes in the coracoacromial arch and correlate these degenerative changes with rotator cuff tears. We obtained 80 shoulders from 40 cadavers. The mean age at death was 58.4 years. We performed a gross examination of the rotator cuff and the acromion and histological examination of the coracoacromial ligament. The statistical significance of any difference for each group considered was determined by Student's t-test. The rotator cuff was normal in 66 specimens; there was an articular-side partial tear in 4 cases, a bursal-side partial tear in 6 cases, and a full-thickness tear in 4 cases. Age was correlated with increasing incidence and severity of cuff tears. We noted age-related degenerative changes in the coracoacromial ligament, degeneration of the acromial bone-ligament junction, and acromial spur formation. Anterior acromial spur was not related to the morphology of the acromion. We observed an increased incidence of bursal-side and complete cuff tears when the acromion was curved or beaked. Degenerative changes in the undersurface of the acromion were also present when the rotator cuff was normal. Bursal-side and complete cuff tears were associated with severe degenerative changes in the acromion in 100% of cases. Articular-side cuff tears were not related either to acromial morphology or degenerative changes in the coracoacromial arch. The association between cuff tears and acromial spur was more evident in the presence of a type III acromion. Our results would suggest that the incidence and severity of rotator cuff tears are correlated with aging and with the morphology of the acromion. Rotator cuff tears that involve the bursal side are often associated with changes in the coracoacromial ligament and the undersurface of the acromion. However, degenerative changes in the coracoacromial arch are always related to aging, also in the presence of a normal rotator cuff. Articular-side partial tears do not cause damage to the undersurface of the acromion.

Acromioclavicular Joint↗
PubMed2001

Subscapularis, medial, and lateral head coracohumeral ligament insertion anatomy. Arthroscopic appearance and incidence of "hidden" rotator interval lesions.

PURPOSE: The purpose of this study was to document the incidence of lesions of the rotator interval, illustrate the arthroscopic appearance of subtle differences in these lesions, and discuss how various lesions may affect biceps tendon stability in the bicipital groove. TYPE OF STUDY: A Data Registry has been used in my office since 1995 (Microsoft Office Access). This study reports on the results of a retrospective database "query" of the prospectively entered data from 1995 to 1998. Thus, by default, the format of this study is a consecutive sample. Only patients with a disruption of rotator cuff tendons, labrum and/or gleno-coracohumeral ligaments are included by study design. METHODS: This study has identified and reports on 46 arthroscopically identified subscapularis tears, 25 "hidden" rotator interval lesions (SGHL/MCHL complex) and 6 SGHL/CHL complex plastic deformation lesions in 165 patients undergoing shoulder arthroscopy for conditions ranging from anterior instability to rotator cuff tears. Arthroscopically identified lesions include partial or complete disruptions of the subscapularis tendon, disruptions of the superior glenohumeral/medial head coracohumeral ligament complex (SGHL/MCHL), disruptions of the lateral head coracohumeral ligament (LCHL), and various combinations of the above. RESULTS: The incidence rate of subscapularis tendon involvement in 165 arthroscopically treated shoulder patients was 27%. The incidence rate of subscapularis tendon disruptions with rotator cuff pathology was 35%. The incidence rate of SGHL/MCHL lesions (tear or stretch) in 165 arthroscopically treated shoulder patients was 18%. The incidence rate of SGHL/MCHL tears in 165 arthroscopically treated shoulder patients was 15%. Forty-seven percent of all subscapularis tears involved the SGHL/CHL complex. Ten percent of all rotator cuff tears involving the supraspinatus tendon involved the LCHL. CONCLUSIONS: This study has recorded the incidence of lesions of the subscapularis, SGHL/MCHL complex and/or the LCHL, and combinations thereof in degenerative cuff and instability patients. Primary lesions of the rotator interval can occur and regardless of the associated pathology, and if these lesions are not repaired, biceps tendon subluxation may exist.

Arthroscopy↗
PubMedDate not supplied

Arthroscopic rotator cuff repair: Analysis of results by tear size and by repair technique-margin convergence versus direct tendon-to-bone repair.

PURPOSE: The purpose of this article is 2-fold: To report the long-term functional results of arthroscopic rotator cuff repair (average, 3.5 years in this study), and to analyze results by tear size and repair technique (margin convergence v direct tendon-to-bone repair). TYPE OF STUDY: Case series. METHODS: Between September 1993 and April 1997, 62 patients had an arthroscopic rotator cuff repair performed by the senior author (S.S.B.). Of this group, 59 patients (59 shoulders) were available for follow-up. Preoperative and postoperative function were assessed by means of a modified UCLA scoring system. Tears were categorized according to size (greatest diameter, number of tendons involved, and pattern of tear [crescent shape v U-shape]). Crescent-shaped tears were repaired in a direct tendon-to-bone fashion and U-shaped tears were repaired by a margin-convergence technique. RESULTS: Good and excellent results were achieved in 95% of the cases, regardless of tear size. The large and massive tears did as well as the small and medium-sized tears. That is, results were independent of tear size (P >.05). Results of tears repaired by margin convergence were not significantly different statistically from those repaired by direct tendon-to-bone repair (P >.05), validating the selection criteria of U-shaped tears for repair by margin convergence. There is a rapid return to full overhead function after arthroscopic rotator cuff repair (average, 4 months for each tear size). Delay from injury to surgery, even of several years, did not adversely affect surgical outcome. CONCLUSIONS: (1) Arthroscopic rotator cuff repair can achieve good and excellent results in a large percentage of patients (95% in this series). (2) Results of arthroscopic rotator cuff repair are independent of tear size. (3) U-shaped tears repaired by margin convergence have results comparable to those of crescent-shaped tears repaired directly by a tendon-to-bone technique. (4) There is a rapid return to full overhead function after arthroscopic rotator cuff repair (average, 4 months for all tear sizes). (5) A delay from injury to diagnosis, even of several years, is not a contraindication to arthroscopic rotator cuff repair.

Arthroscopy↗
PubMed1997

[The biceps-/rotator cuff-index in ultrasound diagnosis of chronic rupture of the rotator cuff].

PURPOSE: Diagnosis of old lesions of the rotator cuff is clinically and sonographically challenging. To improve the sonographic diagnosis of old rotator cuff tears the index was developed. METHOD: In a prospective study 100 patients were examined by ultrasound to evaluate standard measures of rotator cuff diameters in relation to the long biceps tendon. The compensating hypertrophy of the biceps tendon was sonographically quantified in relation to the rotator cuff diameter. RESULTS: The pathological study group included 50 patients with an old lesion of rotator cuff (> 3 months). The control group consisted of 50 patients without any lesions. Comparison of both groups revealed a significantly higher biceps/rotator cuff ratio (p < 0.05). Data higher than 0.8 represent a pathological ratio (Index positive), the standard is 0.5. The index is independent of sex and age. There are no significant index changes measurable in acute tears of the rotator cuff. CONCLUSION: The index helps to improve sensitivity in diagnosis of old rotator cuff tears by ultrasound.

Adult↗
PubMedDate not supplied

A comparison of clinical estimation, ultrasonography, magnetic resonance imaging, and arthroscopy in determining the size of rotator cuff tears.

This prospective study was undertaken to compare the ability of clinical estimation, diagnostic ultrasonography, magnetic resonance imaging, and arthroscopy to estimate the size of rotator cuff tears. Estimates of rotator cuff tear size were compared with the findings at open operation in 33 consecutive patients with a presumptive diagnosis of rotator cuff tear. Arthroscopy estimates of rotator cuff tear size correlated best with actual tear size (Pearson correlation coefficient r = 0.92; P <.001). Magnetic resonance imaging (r = 0.74; P <.001) was similar to ultrasonography (r = 0.73; P <.001). Estimates of rotator cuff tear size after clinical assessment alone had weaker correlation coefficients (r = 0.41; P =.02) than the other methods. Each method underestimated rotator cuff tear size by 12%, 30%, 33%, and 38%, respectively. No method was able to determine the size of partial-thickness rotator cuff tears (r < 0.02).

Aged↗
PubMedDate not supplied

Acromial shapes and extension of rotator cuff tears: magnetic resonance imaging evaluation.

Magnetic resonance imaging makes it possible to inspect the status of the rotator cuff and the shape of the acromion. To clarify the relationship between acromial shapes and rotator cuff tears, we evaluated magnetic resonance images obtained in 192 shoulders. We classified the acromial shapes into 3 types: type I (flat), type II (curved), and type III (hooked). Among a group of 91 shoulders with rotator cuff tears, 33 (36.3%) were type I, 22 (24.2%) type II, and 36 (39.6%) type III. The size of rotator cuff tears in type III acromions was significantly larger than in type I or II acromions. Comparison of the incidence of each acromial shape between groups of specimens with and without rotator cuff tears revealed no significant differences. We suggest that whereas acromial shapes have a bearing on the extent of rotator cuff tears, the correlation between rotator cuff tears and a type III acromion is not as strong as has been suggested in the literature.

Acromion↗
PubMedDate not supplied

Infection after mini-open rotator cuff repair.

A consecutive case series from 2 institutions of patients with postoperative wound infections after mini-open rotator cuff repair was reviewed. Between 1991 and 2000, 360 patients underwent mini-open rotator cuff repair after arthroscopic subacromial decompression. Seven patients had postoperative infection develop (1.9%). All patients were men, with a mean age of 55 years (range, 40-64 years). Treatment included serial irrigation and debridement, long-term intravenous antibiotics, and revision rotator cuff repair. Mean follow-up after definitive treatment was 32 months (range, 12-57 months). Propionibacter acnes was present in 6 of 7 patients (86%) with infections. The initial rotator cuff repair was disrupted in 4 shoulders and intact in 3. A revision rotator cuff repair was performed at the final irrigation and debridement in all 4 shoulders. Results were 100% satisfactory. The mean American Shoulder and Elbow Surgeons pain score improved from 7 (range, 6-9) preoperatively to 1 (range, 0-2). The mean final score was 95. Because these infections were noted to occur only in arthroscopically assisted rotator cuff repairs, a second preparation and draping were introduced as routine protocol. No postoperative infections have occurred in the ensuing 200 mini-open rotator cuff repairs.

Adult↗
PubMed2003

Glenoid inclination is associated with full-thickness rotator cuff tears.

Anatomic factors, such as a hooked acromion, have been associated with rotator cuff disorders. Orientation of the glenoid relative to the scapula has been implicated in shoulder instability, but it has not been linked to rotator cuff disorders. The purpose of the current study was to test the hypothesis that superior inclination of the glenoid is associated with full-thickness rotator cuff tears. Glenoid inclination angles were measured from 16 shoulder radiographs of a convenience sample of eight cadavers in which one shoulder had an intact rotator cuff and the other shoulder had a full-thickness rotator cuff tear. Glenoid inclination angles for shoulders with rotator cuff tears were compared with contralateral normal shoulders using nonparametric statistical analysis. The glenoid inclination angle was greater in cadaver shoulders having full-thickness rotator cuff tears (98.6 degrees ) than in shoulders without tears (91.0 degrees ). A second experiment was done to assess the reliability of using 34 Grashey view radiographs from a clinical population to measure glenoid inclination angle. A method to measure the glenoid inclination on Grashey views was tested and was found to correlate with the inclination angles measured on cadaveric scapulae. Intrarater reliability of measurements from clinical Grashey views was 0.93, and interrater reliability was at least 0.88.

Aged↗
PubMed2005

Functional outcome and health-related quality of life after surgical repair of full-thickness rotator cuff tear using a mini-open technique.

BACKGROUND: Rotator cuff tear, a common shoulder injury, can lead to shoulder pain and functional loss. HYPOTHESIS: Surgical repair of full-thickness rotator cuff tears using the mini-open surgical technique will improve shoulder function and health-related quality of life. STUDY DESIGN: Cohort study. Level of evidence, 2. METHODS: Patients with a full-thickness rotator cuff tear who underwent a mini-open repair were evaluated for (1) active shoulder range of motion preoperatively, and 6 months and 12 months postoperatively and (2) health-related quality of life preoperatively, 6 months postoperatively, and annually up to 5 years postoperatively. Satisfaction with the repair and return to work status were ascertained 1 year postoperatively. A subgroup analysis of tear size and patient age was also undertaken. RESULTS: Of the subjects, 61 (73%) were men, and the average age was 53.2 ( +/- 9.9) years. According to repeated-measures analysis of variance, shoulder range of motion (flexion and external rotation) improved significantly from before surgery to 1 year after surgery (P <.001). The mean American Shoulder and Elbow Surgeons scores improved from 53.3 ( +/- 20.6) preoperatively to 90.6 ( +/- 11.7) 1 year postoperatively (P <.001). The mean Western Ontario Rotator Cuff scores also improved from 43.2 ( +/- 20.2) preoperatively to 87.2 ( +/- 14.3) 1 year postoperatively (P <.001). No differences were seen in either the American Shoulder and Elbow Surgeons scores or Western Ontario Rotator Cuff scores between the 1-year examination and the last follow-up assessment undertaken at a median of 5 years postoperatively (P >.05). Ninety-six percent of patients were satisfied or very satisfied with the results of their repair; 78% of patients who were working before surgery returned to work without modification by 1 year postoperatively. For the most part, patient age and size of tear did not influence postoperative range of motion or health-related quality of life. CONCLUSION: Mini-open rotator cuff repair led to improved shoulder function and health-related quality of life up to 5 years postoperatively.

Adult↗
PubMed2006

Outcome and structural integrity after arthroscopic rotator cuff repair using 2 rows of fixation: minimum 2-year follow-up.

BACKGROUND: Although arthroscopic repairs of the rotator cuff are becoming increasingly popular, security of fixation remains a concern. Two-row repairs have been described, but clinical outcome reports have primarily involved open techniques. HYPOTHESIS: An arthroscopic repair technique that uses 2 rows of fixation produces satisfactory outcome and structural integrity by ultrasonography. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: Forty-eight patients (52 shoulders) with a full-thickness, but fully reducible, rotator cuff tear who met the inclusion criteria were treated with an arthroscopic rotator cuff repair using 2 rows of suture anchors. The mean tear size was 2.47 cm (range, 1-4 cm). Patients were evaluated by subjective functional assessment (L'Insalata Shoulder Rating Questionnaire), clinical examination, including measured strength testing, and ultrasonography. RESULTS: At a mean follow-up of 30 months (minimum of 2 years), functional scores improved from a mean of 42 preoperatively to 93 postoperatively (P < .001). Active range of motion was increased in all measured planes (P < .001). Strength was also increased in elevation (P < .001), external rotation (P < .001), and internal rotation (P = .033). Nine of the 52 shoulders (17%) had evidence of retear or persistent defect on postoperative ultrasonography. There were no differences detected in functional scores between those with an intact repair and those with a defect, but those with an intact repair were stronger in elevation (P = .006) and external rotation (P = .001). CONCLUSION: An arthroscopic 2-row rotator cuff repair produces excellent functional outcome and repair integrity comparable with previously reported open repairs. Presence of a defect after repair did not appear to affect patient-reported function and return to preinjury activity but did affect measured strength.

Adult↗
PubMedDate not supplied

Excursion of the rotator cuff under the acromion. Patterns of subacromial contact.

Nine fresh-frozen, human cadaveric shoulders were elevated in the scapular plane in two different humeral rotations by applying forces along action lines of rotator cuff and deltoid muscles. Stereophotogrammetry determined possible regions of subacromial contact using a proximity criterion; radiographs measured acromiohumeral interval and position of greater tuberosity. Contact starts at the anterolateral edge of the acromion at 0 degrees of elevation; it shifts medially with arm elevation. On the humeral surface, contact shifts from proximal to distal on the supraspinatus tendon with arm elevation. When external rotation is decreased, distal and posterior shift in contact is noted. Acromial undersurface and rotator cuff tendons are in closest proximity between 60 degrees and 120 degrees of elevation; contact was consistently more pronounced for Type III acromions. Mean acromiohumeral interval was 11.1 mm at 0 degrees of elevation and decreased to 5.7 mm at 90 degrees, when greater tuberosity was closest to the acromion. Radiographs show bone-to-bone relationship; stereophotogrammetry assesses contact on soft tissues of the subacromial space. Contact centers on the supraspinatus insertion, suggesting altered excursion of the greater tuberosity may initially damage this rotator cuff region. Conditions limiting external rotation or elevation may also increase rotator cuff compression. Marked increase in contact with Type III acromions supports the role of anterior acromioplasty when clinically indicated, usually in older patients with primary impingement.

Acromion↗
PubMed2003

Prognostic indicators for outcome following rotator cuff tear repair.

PURPOSE: To examine the prognostic indicators associated with outcome following rotator cuff surgery. METHODS: A retrospective evaluation of records on 1120 shoulders (1067 patients) with rotator cuff tear treated by surgery was performed. Preoperative, intra-operative and postoperative factors were analysed by Kendall's Tau-b correlation analysis and logistic regression analysis. RESULTS: Positive correlations were seen between the type of tear and the number of tendons involved, retraction, age, degeneration, subacromial bone spur, surgical technique, preoperative and postoperative muscle power, surgical outcome, and preoperative abduction on Kendall's Tau-b analysis. There was a positive correlation seen between degenerative change and age, number of tendons involved, retraction, preoperative pain, tear type, and preoperative musclepower on logistic regression analysis. Additionally, positive correlations were seen between good surgical postoperative outcome and postoperative activities of daily living, preoperative pain, postoperative muscle power, preoperative activities of daily living, tear type, preoperative external rotation, preoperative muscle power, number of tendons involved, preoperative pain, and duration of symptoms. CONCLUSION: Ageing was found to be the major factor in progressive degeneration of the rotator cuff, and should be considered the single most important contributing factor in the pathogenesis of rotator cuff tears. In addition, degenerative tendonopathy appeared the primary pathology in rotator cuff tear, preceding hypertrophic spur formation. Rotator cuff tears are therefore unlikely to be initiated by impingement; rather, they develop as an intrinsic degenerative tendonopathy.

Adolescent↗
PubMed2000

The results of repair of massive tears of the rotator cuff.

BACKGROUND: Massive tears of the tendons of the rotator cuff cause atrophy and fatty degeneration of the rotator cuff muscles and painful loss of function of the shoulder. Repair of massive rotator cuff tears is often followed by retears of the tendons, additional muscular degeneration, and a poor clinical outcome. The purposes of this study were to determine whether a new method of repair of rotator cuff tendons can yield a lower retear rate and a better clinical outcome than previously reported methods, to assess the muscular changes following repair of massive tears of the musculotendinous units, and to correlate findings on magnetic resonance imaging with the clinical results. METHODS: Twenty-nine massive rotator cuff tears involving complete detachment of at least two tendons were repaired operatively with use of a new laboratory-tested technique in a prospective study. At least two years (average, thirty-seven months; range, twenty-four to sixty-one months) postoperatively, twenty-seven patients were evaluated clinically and with magnetic resonance imaging to determine the clinical outcome, the integrity of the repair, and the condition of the rotator cuff muscles. RESULTS: The age and gender-adjusted Constant score improved from an average of 49 percent preoperatively to an average of 85 percent postoperatively, corresponding to a subjective shoulder value of 78 percent of that of a normal shoulder. Pain-free flexion improved from an average of 92 degrees to an average of 142 degrees, and abduction improved from an average of 82 degrees to an average of 137 degrees. Pain decreased and performance of activities of daily living improved significantly (p < 0.05). The seventeen patients who had a structurally successful repair all had an excellent clinical outcome. Muscle atrophy could not be reversed except in successfully repaired supraspinatus musculotendinous units. Fatty degeneration increased in all muscles. CONCLUSIONS: The method of repair of massive rotator cuff tears that was used in this study yielded a comparatively low retear rate and good-to-excellent clinical results; however, the repair did not result in substantial reversal of muscular atrophy and fatty degeneration. Retears occurred more often in patients who had had a shorter interval between the onset of the symptoms and the operation (p < 0.05). Patients who had a retear had improvement of the shoulder compared with the preoperative state, but they had less improvement than did those who had a successful repair.

Activities of Daily Living↗
PubMed2002

Mechanical strength of arthroscopic rotator cuff repair techniques: an in vitro study.

BACKGROUND: Retears after rotator cuff repairs occur relatively frequently and may compromise the functional result. The goal of this study was to analyze the mechanical properties following arthroscopic techniques for rotator cuff repair and to evaluate possible alternative techniques. METHODS: In the first part, five different bone anchors (the Revo screw; Mitek Rotator Cuff anchor, 5.0-mm Statak, PANALOK RC absorbable anchor, and 5.0-mm Bio-Statak) were tested in vitro under cyclic loading on five pairs of cadaveric shoulders. Then five types of arthroscopic tendon suturing instruments were tested on rotator cuff tendons. Finally, the arthroscopically performed mattress and modified Mason-Allen stitches, fixed with either the Revo screw or the Bio-Statak, were evaluated on ten pairs of human cadaveric shoulders. RESULTS: The holding strengths of the various anchors were similar, ranging from 130 to 180 N, and approximated the holding strength of knotted number-2 suture materials. The fixation of the tested anchors yielded comparable values of stiffness except for one anchor, which showed significantly greater subsidence under cyclic load (p = 0.003). All tested, commercially available arthroscopic suturing devices were unsuitable for performing a modified Mason-Allen stitch on normal supraspinatus tendons. Modification of a commercially available suture punch with a longer needle allowed us to consistently perform a modified Mason-Allen stitch. The modified Mason-Allen stitch, which has shown favorable mechanical properties in open repairs of the rotator cuff, was not found to be stronger than the mattress stitch when performed arthroscopically and used with bone anchors. When the modified Mason-Allen stitch was fixed to one anchor, it was even weaker than a mattress stitch repaired with another anchor (168 versus 228 N). Unequal loading of the two suture branches due to the more rigid modified Mason-Allen stitch may be the reason for this difference. CONCLUSIONS: Arthroscopic techniques for rotator cuff repair with use of the mattress stitch and bone anchors allow for a relatively solid fixation. The holding strength is not improved with use of the modified Mason-Allen stitch. Although a direct comparison with previous in vitro studies is not possible, the holding strength of open fixation techniques seems to be stronger. If rotator cuffs are subjected to high postoperative loading, open repair might be preferred to reduce the risk of a retear, until stronger arthroscopic fixation techniques are developed.

Arthroscopy↗